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Health Affairs, 25, no. 6 (2006):
1472-1473
doi: 10.1377/hlthaff.25.6.1472 © 2006 by Project HOPE |
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From the Editor |
Will Employer-Sponsored Health Insurance Endure?
THE U.S. RELIANCE ON PRIVATE HEALTH INSURANCE COVERAGE that is voluntarily provided by employers is unique among industrialized nations. Since World War II, this enterprise has become deeply embedded in, if not always appreciated by, American culture. In 2000, employment-based coverage reached its enrollment peak—164.4 million covered lives—but by 2004, that number had declined by some five million. Despite this decline, the commercial health insurance enterprise has enjoyed a period of robust financial growth in recent years, as most companies have successfully managed their way through a difficult period. However, the challenges are far from over. In the political realm, both the Right and the Left are calling for fundamental changes in the way health care is insured, with one calling for greater reliance on individual coverage and responsibility and the other relying more heavily on expanding publicly sponsored programs. More and more employers are asking whether they can continue to afford to offer coverage to their workers.
One of the themes that we have returned to consistently over our twenty-five years of publication is the state of the private insurance industry, and we are revisiting that subject again in this issue. There is clearly a lot to write about, as health care expenditures continue to grow more rapidly than the general economy and are, in turn, driving rates of private insurance down while public programs grow along with an uninsured population that is approaching fifty million Americans. In our lead paper, contributing editor James Robinson reports on new types of public-private arrangements that have been strongly advocated by the Bush administration and the Republican-controlled Congress. Other papers touch on issues that are challenging the insurance industry and society as well: the "graying" of group health insurance; the continuing decline in employers’ willingness to subsidize retirees’ health care coverage; and a forum on whether employer-sponsored insurance can be saved.
Several additional papers address the problem of expanding coverage. A section on policy initiatives and experiments explores a sampling of current initiatives. Martin Feldstein, former chairman of the Council of Economic Advisers, contributes a theoretical discussion on "Balancing the Goals of Health Care Provision." Other papers examine trends in coverage among Latinos, consumers’ views on benefit design, and employers’ opinions on incremental coverage initiatives.
We acknowledge with gratitude the support provided by the California HealthCare Foundation (CHCF), which enabled us to focus this issue on the future of the health insurance industry. The foundation’s health insurance program, headed by Jill Mathews Yegian, has since its inception supported research on health insurance and made extensive efforts to extend coverage to uninsured Californians. The CHCF recently announced plans to launch an ambitious multiyear project with the Robert Wood Johnson Foundation that will address a fundamental question related to consumer-directed insurance benefits: How does this model influence the use and quality of medical care, particularly for people who are poor and sick? RAND will conduct the research over a four-year period in partnership with Watson Wyatt Worldwide.
| Health Affairs launches blog. |
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After twenty-five years as a bimonthly print journal and six years in online publishing, Health Affairs has entered the blogosphere as a new means of engaging readers in the health policy debate. The journal is all about an ongoing dialogue on health policy issues of concern to a diverse audience of interested readers. The blog, which we launched in early October, should enable the journal to move beyond the 4,000-word research paper into a new realm: thoughtful, focused comments in the 500-to-1,000-word range, on topics that scan the health policy horizon. The contents of the blog are not peer-reviewed, but all posts are vetted and posted by the journal’s editors.
At the outset, Health Affairs plans to experiment with the blog. Some posts will be clustered around a hot topic. Some will be one-time postings on news items of current interest. Linking and interactivity will be key. Both staff editors and outside experts will be contributing items to the blog. Our goal is to offer a range of views, not to push a particular agenda. Anyone is welcome to comment, but all must register and agree to the terms of use, including the use of real names, not pseudonyms. We will filter comments for appropriateness and language. New content will be posted on the blog several times a week. You can sign up for e-mail alerts or an RSS feed to be alerted when new content is posted. Come join us on this new venture, and let us know how we are doing.
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HOPE–The People-to-People Organization |
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